Chaney v. U.S. Fidelity & Guaranty, 276 Mont. 513, 917 P.2d 912 (1996) Where Workers’ Compensation Court found that insurer’s failure to accept or deny a claim within thirty days constituted acceptance as a matter of law (see § 39-71-606(1), MCA, and Haag v. Montana Schools Group Ins. Auth., 274 Mont. 109 (1995)), the Court erred in failing to hold the insurer liable for claimant’s present condition. Once a claimant shows acceptance of a claim as a matter of law under Haag, and that his original injury was the same kind of injury to the same parts of his body for which he now seeks benefits, he has met his initial burden of proof. To avoid liability, the insurer must then show that claimant attained maximum medical healing and suffered another injury causing his present condition, not shown in this case.

Engle v. Hartford Underwriters Ins. Co. [12/31/13] 2013 MTWCC 27 Where the insurer paid for all of Petitioner’s elbow treatment from 2005 forward, even when the medical records indicated that the treatments were for various conditions, the Court rejected the insurer’s argument that it only accepted one specific elbow condition and denied all others.

Engle v. Hartford Underwriters Ins. Co. [12/31/13] 2013 MTWCC 27 The Court rejected Respondent’s contention that it had accepted liability for only one specific condition and not the entirety of Petitioner’s elbow problems. A claims adjuster referred to Petitioner’s elbow problems as “current complaints” and acknowledged that a physician had opined that Petitioner’s job duties had accelerated the natural progression of her underlying elbow disease. The Court found that Respondent never made a distinction between any specific conditions in Petitioner’s elbow, nor did its acceptance letter indicate that it believed Petitioner suffered from two unrelated conditions.

Clapham v. Twin City [08/01/12] 2012 MTWCC 27 Section 39-71-606(5), MCA, which specifically limits the remedies available for noncompliance with the statute to attorney fees and a penalty, likewise applies to claims placed under § 39-71-608, MCA. It would be absurd to hold an insurer who invokes § 39-71-608, MCA, potentially liable for automatic acceptance of the claim while an insurer who simply denies the claim would not face the possibility of this action.

Bell v. Montana State Fund [08/02/11] 2011 MTWCC 23 On a claim for which the insurer previously accepted liability but sent a letter denying a specific medical treatment, the letter does not create the existence of a dispute over liability of the claim in general such that the statute of limitations under § 39-71-2905(2), MCA, would begin to run on the entire claim.

Narum v. Liberty Northwest Ins. Corp. [06/04/08] 2008 MTWCC 30 Where, after reviewing the medical evidence and doctors’ opinions, Respondent accepted liability for Petitioner’s left hip condition and settled the claim with medical benefits left open, and where the settlement agreement stated that the parties acknowledge Petitioner may require a hip replacement in the future, Respondent cannot refuse to pay for the hip replacement surgery, arguing that it is not causally related to Petitioner’s industrial accident.

UEF
v. Big Sky Petroleum, Montana State Fund, and Melvin J. Strong [4/29/04]
2004 MTWCC 39 Insurer may rescind acceptance of claim and
deny further benefits for fraud or misrepresentation which vitiates the
acceptance. Where insurer accepted claim based on an incorrect date of
injury which was supplied by employer and did not insure the employer
on the date when the injury in fact occurred, the insurer properly rescinded
its acceptance and denied further benefits.

UEF
v. Big Sky Petroleum, Montana State Fund, and Melvin J. Strong [4/29/04]
2004 MTWCC 39 Where the claimant informs the insurer that
his industrial accident occurred on a date different than the one set
out in the accepted claim, and the insurer did not cover the employer
on the actual date of injury, the action of the claimant in informing
the insurer amounts to a withdrawal of his claim with respect to that
insurer and effectively amends the claim to incorporate the correct date.
Under such circumstances, the acceptance of the claim is mutually rescinded.

Gunder
v. CIGNA [5/3/99] 1999 MTWCC 31 Claimant appealed from the
decision of Department of Labor holding that failure of the insurer
to deny an occupational disease claim within 30 days does not preclude
the insurer from contesting the claim. Claimant asked the WCC to find
the "retroactive" application of section 39-71-606(5), MCA
(1997) unconstitutional. That section, which specifies that failure
to deny within 30 days does not constitute acceptance, was expressly
made applicable by the Montana Legislature to matters pending prior
to its enactment. The WCC held that application of section 39-71-606(5),
MCA (1997) to claims existing prior to the effective date of the statute
does not violate the contract clause of either the Montana or United
States Constitutions. Given the statement in section 39-72-103, MCA
(1995) that rights to compensation for occupational diseases did not
vest and could be changed by the legislature, an occupational disease
claimant had no contractual right to benefits as described in a particular
year's legislation. Given this and in light of applicable precedent,
the retroactive application of the 1997 amendment to section 39-71-606(5),
MCA was constitutional. (Note: the
appeal to the Montana Supreme Court, Gunder v.
CIGNA, No. 99-337, was ordered
dismissed on May 18, 2000, based upon notice from the parties that the
matter had settled.)

Hall
v. State Fund [1/13/99] 1999 MTWCC 3 Once claimant's physical
condition was accepted as an OD, WCC would not enter debate about whether
the diagnosis of the condition was correct. Compensability does not turn
on the validity of the diagnosis, but requires only that the claimant
suffer an injury or disease of some sort and be disabled as a result.

Wylie
v. State Fund [4/3/97] 1997 MTWCC 17 Where section 39-71-606(1),
MCA, requires an insurer to accept or deny a claim "within 30 days
of receipt of a claim for compensation," it is the insurer's receipt
of a claim that triggers the obligation, not the employer's.

Guedesse
v. Liberty Mutual Fire Insurance Company [3/12/97] 1997 MTWCC 10Where the claim form signed
by claimant did not state any specific event or any specific time
or place for an alleged injury, it fails to identify an industrial
accident or injury within the meaning of the Workers' Compensation
Act. The "automatic
acceptance" rule ofHaag v. Montana
Schools Group Ins. Authority, 274
Mont. 109, 906 P.2d 693 (1995) comes into play only if the insurer
has received a valid claim for injury, containing sufficient information
to inform the employer and insurer of the nature and basis of the claim.
As the insurer argues, the claim submitted in this case, at best, suggests
claimant is suffering from an occupational disease, and the insurer accepted
the claim as such.

Bouldin
vs. Liberty Northwest Insurance Corp. [10/8/96] 1996 MTWCC 61Under
the 1995 version of the Occupational Disease Act, in a denied liability
case, the DOL, not the WCC, has original jurisdiction to conduct a de
novo hearing into whether claimant has an occupational disease. However,
the WCC has jurisdiction to determine whether the insurer's initial acceptance
of the claim bars subsequent denial. Where the insurer concedes claimant's
present condition is the same condition for which she filed the initial
claim, the insurer is barred from later denial.